Provider Demographics
NPI:1124910807
Name:BERRY, ADRIENNE LEIGH
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4563 PLUTO RD
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-8064
Mailing Address - Country:US
Mailing Address - Phone:304-575-6080
Mailing Address - Fax:
Practice Address - Street 1:4563 PLUTO RD
Practice Address - Street 2:
Practice Address - City:SHADY SPRING
Practice Address - State:WV
Practice Address - Zip Code:25918-8064
Practice Address - Country:US
Practice Address - Phone:304-575-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency